Map of life expectancy at birth from Global Education Project.

Tuesday, April 19, 2011

That'd be the butt, Bob . . .

As a classic example of answering the wrong question. (Go here if you don't know what it means, or don't bother if you'd rather not know.)

It hardly seems worth my while to discuss the unanimous vote of the Republicans in the House to do away with Medicare. If you're reading this blog you probably know what I'm likely to say, right? And there are others with much more visible platforms from which to say it. But I do perhaps have a tweak or two to offer.

First, here's James Fallows, making the point that without Medicare, many old people would face ruinous health care costs that would wipe out their estates. That's true, although the implied universality isn't quite right. Some people are lucky enough to die suddenly, without a costly terminal illness. But there's certainly no justice in that random selection.

However, the fact is that this already happens to a lot of people. Medicare does not pay for long-term care -- past six months in a nursing home, people have to spend down their estates and become impoverished, then Medicaid takes over. If you happen not to need long term care, but do need expensive medical care that Medicare does cover, then essentially the taxpayers are chipping in to protect your estate for your heirs. If it just so happens that you develop a long-term terminal illness -- dementia being the archetypal example -- your heirs don't get that benefit.

That doesn't seem particularly just either. To me, what this really invites us to think about is the basic problem of people entitlement to inherit their parents' left-over retirement savings.

The real reason to keep Medicare is not the protection of heirs, as Fallows suggests, but because it is the most cost-effective and just way to provide health care to the elderly that we currently have, and because it could be made even more cost effective and just with some policy changes -- including precisely the policy changes that Republicans decry as "death panels." They don't even want to bother with the death panels, obviously, they just want to let poor people die.

However, Fallows seems to be basing his argument on your right to inherit. That seems to be the wrong question.


kathy a. said...

naturally, i agree with your assessment. i've got no interest in protecting inheritances.

the much more pressing problems with eliminating medicare and medicaid are on the opposite end of the lottery -- a long illness without these protections could mean devastating choices for families. abandon mama to die alone, or cripple her family with ruinous debt at a time when they are trying to support themselves and their own families? which sibling gives up a career to be the caretaker? do we sue an adult child who doesn't contribute, or let all the burden fall on the ones who do?

acute and lingering illnesses already place large burdens on families. there is no way to predict who will die fast, who will die slowly and expensively. should we send the kids to college, or save that money in case we are unlucky in later years?

roger said...

conservatives hate the "death tax" so they should love "inheritance protection."

i confess that i do think more families should care for parents who don't need medical treatment. i know that's a burden. go to one of those places where the old are warehoused and tell me what a joyful existence they have.

i also think we should have medicare for all from birth.

kathy a. said...

roger, i agree in principle with caring for elders when possible -- and i think it's great that you and robin and mom are trying that out! being at home and with family is obviously best, when that can be managed.

in the case of my grandmother, it was not possible. when i became her caretaker, i was working full time at a new job and the major breadwinner, my husband was in school and working part-time, our kids were very young, our house was small and not accessible. she was bedridden and needed heavy-duty nursing care those last 6 years, with periodic hospitalizations. she had alzheimer's and delsions/hallucinations, as well.

it was as much as i could do, managing her affairs, providing extras, and visiting frequently. the hell of it is, that much was really a lot of work -- i did not know how less connected people could wrangle the paperwork [especialy medicaid, but lots of paper all around], finding a decent enough place, sorting medical decisions, grappling with the mental weirdness, etc. said...

No doubt, the writer is completely right.

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